The one thing that seems to be lost in the debate over funding Obamacare: the patients.

That’s also the opinion of physician and novelist Abraham Verghese, senior associate chairman for the theory and practice of medicine at Stanford University.

“We’ve worried so much about the process, not the patient,” Verghese said. “If the purpose of Obamacare is to help people get health insurance; if its purpose is to not punish people with pre-existing conditions; if its purpose is to promote quality health care … then what’s so bad about it?”

Verghese spoke Sept. 30 at the University of Denver for a Denver Post-sponsored lecture series called Pen and Podium. He was there to discuss his 2010 novel, “Cutting for Stone,” but his talk frequently drifted out of the realm of literature and into the hot-button issue of Obamacare.

Doctors today make a lot of money ordering tests in the emergency room, Verghese said. “So much of medicine is driven by the reimbursement.”

Too often “doctors are paid to do things to patients, not for them,” he added.
“Whatever Obamacare does, it will put a premium on not ordering medical tests willy-nilly,” he said. “It will force physicians to come up with a rational idea of what to do next.”

Early in his career, Vergehese worked as a night orderly in a hospital in India, and called that “the most precious learning I could have had,” describing doctors who could “read the body as a text.”

It was from that experience that Verghese developed a cause: the physical exam — what he calls the lost art of bedside diagnosis — and its role in cutting health care costs.

Verghese is critical of what he calls “the iPatient,” lamenting the fact that technological advances have pushed hands-on medical care onto computer screens. “Patients today are getting great care,” he said, “but only in the computer, not in person.”

He believes that the loss of the physical exam has put a barrier between the doctor and patient, and that a lot of information has been lost along with it. “A physical exam is a ritual. Someone is telling me their intimate details, allowing themselves to be touched. That’s a ritual that’s important to patient care. They need to know you are capable of more than a rub on the belly and a listen to their heartbeat.”

Early in his career, Verghese was summoned to the bedside of a patient dying of AIDS in Tennessee, where he had a practice. The man had not opened his eyes or eaten anything in days, and his family feared the end was near.

As Verghese approached and spoke to the bed-ridden patient, the man’s hands fluttered, reaching up toward his chest … for the buttons on his shirt, so Verghese could examine him.

“He was making an offering to me,” Vergehese said. “The ritual was as significant to him as to me, saying ‘Here I am. I’m here for you.’”

We also have become too focused on the cure, he argues. Instead, we should not lose site of human beings who need healing, even when there is no cure to be found. Doctors should never forget that medicine is, after all, all about a human interaction.

Toward the end of his talk, Verghese described a plaque in his office: “To love the sick” — and here he had to stop to compose himself, overwhelmed by the message — “as if they were your own.”